Medication reconciliation challenges at discharge from hospital using an electronic medication management system and electronic discharge summaries

Abstract

Background: Continuity of care can be facilitated by reconciling changes made to electronic discharge medicines profi les (eDPs) in the electronic medication management system (eMMS) and electronic discharge summaries (eDSs). Aim: To review eDPs containing discrepancies and to discern the proportion of discrepancies reconciled in the eMMS and eDSs. Method: All eDPs presented to the pharmacy during 4 one-week periods: September/October 2009, March 2011, January 2012, February/March 2012 were reviewed retrospectively. eDPs with changes were identifi ed and the number, type of changes and potential severity assessment were recorded. An eDS was introduced in January 2012, with discharge medicines listed in the eMMS populating the eDSs. eDPs identifi ed by the pharmacist as requiring edits by the prescriber were cross checked with the fi nal version in the eMMS and eDSs. Results: Number of eDPs reviewed were: 67 (2009), 150 (2011) and 382 (2012). Percentage of eDPs with changes made were: 40% (2009), 33% (2011) and 20% (2012). Percentage of items on eDPs with changes not reconciled in the eMMS were: 100% (2009), 81% (2011) and 31% (2012) (p < 0.0001). Of the eDPs that had changes made, 59% (34) had accurate eDSs in 2012 compared with 11% of handwritten discharge summaries in 2009. Conclusion: While there has been a substantial improvement in the reconciliation of discharge medicines in the eMMS, further work is required to ensure these are imported into the eDSs so that an accurate list is maintained in both systems.